Op-Ed: Surrogate Wombs and Reproductive Outsourcing

Today, the NY Times published an article entitled, “India Nurtures Business of Surrogate Motherhood.” The article describes the rapidly expanding business of “reproductive outsourcing” to India, through which fertility clinics “provide surrogate mothers for foreigners.” The cost for the procedure comes to roughly $25,000 for the foreign couple, and pays the surrogate mother approximately $7,500. In order to regulate the enterprise and maintain ethical standards, the Indian Government is considering the passage of legislation to “govern surrogacy”, but both the content of the legislation, including enforcement mechanisms, remain unresolved.

In the meantime, there are only a few doctors providing this service in India, but the business is certain to expand as demand for surrogate mothers rises from foreign countries. Critics fear that the surrogacy business will fall prey to exploitation, victimizing underprivileged Indian women in the process. As of now, proponents of this new phenomenon contend that both parties stand to benefit from the transaction, but I do not believe it is quite as simple as that. More than market forces are at play here.

It’s important not to lose sight of the fact that we are speaking of transacting in lives, not goods. In fact, one could argue that the only reason this is possible is because the Indian women involved in this transaction are poor, and the foreigners are (comparatively speaking) wealthy. Would these women opt to be surrogate mothers if they were not poor? Most likely not. Are these surrogate mothers really making the choice (and this is a tricky word in this context) to be bear these children? My concern is that this isn’t truly a choice, because unfortunately, poverty speaks louder than anything else

This seems to be a blurry line. Effectively, what are we saying here? Are poor people in developing countries objects that their rich counterparts can rent out cheaply? Are their body parts for sale? Poor people’s body parts should not be bartered, rented, or sold to the highest bidder in a developed country. It speaks to a gross inequality – condoning this practice, to me, seems an implicit way of accepting global economic and social disparities. In a country like India, which has a bloated bureaucracy as it is, something like this would be very difficult to regulate, thereby potentially jeopardizing the lives of poor women.

In fact, I’ll go so far as to say that this is the modern-day equivalent of imperialism. Developed countries may not be physically occupying poorer developing nations, but in this case, they are certainly occupying the wombs of its women.

But I have another, even greater concern. If women do decide to become surrogate mothers of their own free will, it is important to take into consideration the physical, emotional, psychological, and social dimensions to surrogate motherhood. There is the very real concern that having a child taken away from you (whether you agreed to it or not), is traumatizing. How do these fertility clinics account for traumatized women post-the transaction? Are there follow-ups with the woman to ensure that she is faring well, physically, emotionally, psychologically, and otherwise? Also, carrying around a baby for 9 months is not only expensive (because quite simply, she needs to eat more, and she needs to eat more nutritious foods), but there is also an opportunity cost involved. Either the woman can do less work (and thus get paid less on a daily basis), or continue to work (and thus endanger her health, and possibly that of the baby). With these questions in mind, how do these agencies care for the woman during the course of her pregnancy? Do they provide her with a nutritious diet and a stipend that accounts for her expenses? Do they compensate her for the work that she misses because of the pregnancy? What about complications? Do these organizations / individuals also pay for medical expenses incurred as a result of the pregnancy? And of course, there’s the social dimension – how do these women deal with the social stigma of carrying a fatherless baby? How does the agency work with the woman to minimize alienation? What if the woman loses her social network as a result of this work? Clearly, the agency / individual wouldn’t take responsibility for that, but what happens then?

These are all very real questions we need to be asking ourselves, because of first and foremost concern is the health and safety of the surrogate mother. In order for this business to be even minimally ethical, we must ensure that the surrogate mother is treated like a whole human being with needs (not just a uterus), both preceding, during, and following the pregnancy.